Differential Diagnosis for Abril's Condition
- Single most likely diagnosis
- Dyshidrotic Eczema (Pompholyx): This condition is characterized by recurrent, itchy vesicles on the palms and soles, often accompanied by dryness, scaling, and fissuring. The fact that water exposure triggers or worsens the rash and the lack of significant itch but presence of discomfort and pain from cracks align with dyshidrotic eczema. The partial response to over-the-counter eczema cream also supports this diagnosis.
- Other Likely diagnoses
- Irritant Contact Dermatitis: Given Abril's avoidance of frequent handwashing and wet environments due to exacerbation of symptoms, irritant contact dermatitis is a plausible diagnosis. This condition occurs when the skin comes into contact with an irritant, leading to inflammation and symptoms similar to those described.
- Hyperkeratotic Eczema (Thickened Skin Variant of Eczema): This condition could explain the scaling and fissuring, especially if the skin has become thickened over time due to chronic inflammation and dryness.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Squamous Cell Carcinoma or Other Skin Cancers: Although rare, any chronic skin condition, especially one that is resistant to typical treatments, should prompt consideration of skin cancers. Biopsy may be necessary to rule out these conditions.
- Infections (Bacterial, Fungal, or Viral): Chronic infections can mimic eczematous conditions and may not respond to standard eczema treatments. A high index of suspicion is necessary, especially if there are signs of infection such as increased redness, warmth, or purulent discharge.
- Rare diagnoses
- Keratoderma: A group of rare skin conditions characterized by thickening of the skin on the palms and soles. While less likely, it could be considered if other diagnoses are ruled out and the condition is particularly resistant to treatment.
- Palmoplantar Keratoderma with Eczematous Changes: Some forms of palmoplantar keratoderma can present with eczematous changes, making this a rare but possible diagnosis if Abril's condition does not fit more common eczematous conditions.